To support patients seeking urgent dental care in the safest possible way during the COVID-19 crisis, NHS England recommends a two-stage patient pathway. The first stage is remote and includes a COVID-19 risk assessment plus dental triage. The clinician’s professional judgement and shared decision-making then determine whether the patient should continue to be managed remotely or in a second, face-to-face stage.
When urgent dental care can be managed remotely, the clinician should provide advice, analgesia or antimicrobials according to prescribing guidelines.
When face-to-face management is needed, the clinician must determine the most appropriate place and time for this, according to patient group, patient risk pathway, and care requirements. Patients with the most urgent care needs should be prioritised.
Some patients are most appropriately seen in a primary care setting but referral to Urgent Dental Care (UDC) services is needed if patients or their household/support bubble contacts have possible or confirmed COVID-19 infection, or they need urgent dental care that is challenging or inappropriate for primary dental services to provide.
The Royal College of Surgeons of England provides a set of guides for triaging and managing urgent and emergency dental care. These include the Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance on triage for acute dental care during the COVID-19 pandemic.
The limitations of remote patient consent
When dental consultations are conducted by telephone, obtaining patient consent is as essential as ever but may be more challenging than in a face-to-face appointment.
A letter from Stagnell and Moore in the British Dental Journal highlights some of the potential issues: “There is a risk due to patients’ comprehension of the intended procedure and the lack of opportunity to fully appreciate or discuss the risks and benefits.”
They add that in remote consultations, a complete exam may not be possible before treatment. So when patients are sent digital information packs including consent forms to complete on their own, they may need additional support to confirm that they understand all the options and the risks and benefits of intended treatment, in order to provide valid consent.
For these reasons, it is worth taking extra time to obtain informed consent from patients. You may find the following reminders useful.
Reminders for telephone triage and consent
- Establish the identity of the patient or their representative and ensure that patient confidentiality can be maintained.
- Make the patient aware of the limitations of telephone triage.
- Take sufficient time to establish the patient’s needs and to provide all the information they require to understand the care options available to them and to give valid consent.
- Obtain express consent before any patient receives treatment, unless emergency treatment is needed to prevent serious harm or safeguard a patient’s life.
- If you are not sure that the patient understands and has capacity to make decisions, consider whether you have valid consent to proceed with treatment.
- Always document remote consultations, including information provided, patient consent, decisions made, advice given and any medication prescribed, with justifications.
- Obtain a signed consent form; this may not always be required but can provide documentary evidence in case of a dispute.
- Follow GDC principles for remote consultations and prescribing wherever possible.
Further information and useful toolkits
- The General Dental Council provides links to guidance on delivering dental services during the COVID-19 pandemic in each of the four UK nations.
- The British Dental Association offers Returning to work toolkits for each UK nation.
- SDCEP also provides a COVID-19: Practice Recovery Toolkit.
- The Faculty of General Dental Practice offers practical advice about remote provision of pre-appointment patient information.